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Customer Survey Form
We are very interested in your feedback about your experience at U-Assist. Please take this short survey to give us your opinion about our services. Your responses will remain anonymous.
Demographic Questions
Date Of Visit
MM
/
DD
/
YYYY
Time Of Visit
HH
:
MM
AM
PM
AM/PM
Race
Please select
Asian
Black/African American
Native American
Pacific Islander
Spanish/Hispanic/Latino
White/Caucasian
Prefer not to answer
Other
Gender
Please select
Male
Female
Rather not say.
Level Of Study
Please select
PhD
Master
Degree
Diploma
Other
Please rate your level of satisfaction with each of the following items below.
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
Please rate your overall experience at U-Assist today.
Support services and facilities
Please rate your level of satisfaction with each of the following items below.
Immediately
Less Than 5 Minutes
Less Than 10 Minutes
10 Minutes
Over 10 Minutes
How long did you have to wait before being attended to by our staff?
Counter No:
200 words max
Please rate your level of satisfaction with each of the following items below.
Yes
No
Was everything explained to you clearly?
Were you treated with respect (courtesy and care)?
Was the waiting comfortable?
Was my appearance (for example my clothes) appropriate?
Was I too harsh (dismissive, etc.) during our session?
Did you find U-Assist Portal user friendly?
Was it easy to find the right counter for your need?
What can we do to assist you better in future dealings? (Please state)
200 words max
Overall, how satisfied are you with your experience at U-Assist?
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